Here’s a comprehensive, NCLEX-sensitive review of Communicable Diseases for your

nursing exam, including transmission, key signs, management, isolation, and nursing priorities:

COMMUNICABLE DISEASES — ALL YOU NEED

TO KNOW (NCLEX Review)

I. Modes of Transmission

Mode Examples
Contact (direct/indirect) MRSA, C. difficile, RSV, herpes
Droplet (large respiratory particles) Influenza, Mumps, Rubella, Pertussis
Airborne (small particles, long-distance) TB, Measles (Rubeola), Chickenpox (Varicella)
Vector-borne Malaria, Dengue, Lyme disease
Fecal-oral Hepatitis A, Cholera, Rotavirus

II. Common Communicable Diseases (NCLEX High-Yield)

1. Tuberculosis (TB)

• Cause: Mycobacterium tuberculosis

• S/S: Cough >3 weeks, hemoptysis, weight loss, night sweats
• Dx: Sputum AFB, chest X-ray, Mantoux (PPD)
• Precaution: Airborne
• Drug Regimen: RIPE - Rifampin, Isoniazid, Pyrazinamide, Ethambutol
• Nursing Tip: Monitor liver enzymes, orange body fluids (Rifampin), give Vitamin B6
with INH

2. Measles (Rubeola)

• S/S: Koplik spots, maculopapular rash, high fever

• Precaution: Airborne
• Vaccine: MMR (live attenuated) — give at 12–15 months & 4–6 years

3. Chickenpox (Varicella)
 • S/S: Vesicular rash (itchy, crusts over), fever
• Precaution: Airborne + Contact
• Vaccine: Varicella vaccine (live)
• Complication: Risk for shingles later

4. Pertussis (Whooping Cough)

• S/S: Violent coughing, inspiratory “whoop”

• Precaution: Droplet
• Vaccine: DTaP for children, Tdap booster in teens/adults
• Nursing Tip: Watch for apnea in infants

5. Mumps

• S/S: Parotid gland swelling, fever, jaw pain

• Precaution: Droplet
• Complication: Orchitis, meningitis
• Vaccine: MMR

6. Rubella (German Measles)

• S/S: Mild fever, rash, lymphadenopathy

• Precaution: Droplet
• High Risk: Pregnant women — risk for congenital rubella syndrome

7. Hepatitis (A, B, C)

Type Transmission Key Points

A Fecal-oral Vaccine available; self-limiting
B Blood, sex, perinatal Vaccine available
C Blood No vaccine; leads to chronic liver disease

8. HIV/AIDS

• Transmission: Blood, semen, vaginal fluid, perinatal

• Precaution: Standard
 • Test: ELISA, Western blot, viral load, CD4 count
• Drugs: ART (antiretroviral therapy) — lifelong
• NCLEX Tips: Prevent opportunistic infections (e.g., Pneumocystis jiroveci)

9. Dengue Fever

• Cause: Flavivirus (vector: Aedes mosquito)

• S/S: High fever, retro-orbital pain, petechiae
• Complication: Dengue hemorrhagic shock — monitor platelets!
• No specific antiviral

10. Scarlet Fever

• Cause: Group A strep

• S/S: Sandpaper rash, strawberry tongue
• Tx: Penicillin
• Precaution: Droplet

III. Precaution Types (Must-Memorize!)

Disease Precaution PPE

TB, Measles, Varicella Airborne N95 mask, negative pressure room
Mumps, Influenza, Pertussis Droplet Mask within 3 ft
MRSA, C. diff, RSV, Scabies Contact Gown + gloves
HIV, Hep B/C Standard Gloves (if exposure risk)

IV. Vaccination NCLEX Focus

Vaccine Given at Notes

MMR, 12–15 months, 4–6 Live vaccine, contraindicated in
Varicella yrs pregnancy/immunocompromised
2, 4, 6 months +
DTaP Protects against tetanus, diphtheria, pertussis
booster
Birth, 1–2 mos, 6
Hep B Given IM at birth
mos
 Vaccine Given at Notes
Annually >6 months
Influenza Inactivated form only under 2 yrs
old

V. NCLEX-Style Quick Drug Notes

Drug Use Key NCLEX Tip

Rifampin TB Red/orange urine, liver toxicity
Isoniazid (INH) TB Give with Vitamin B6 (prevent neuropathy)
Oseltamivir (Tamiflu) Influenza Give within 48 hrs of symptom onset
Acyclovir Herpes, Varicella Hydrate well, monitor kidney function
Penicillin Strep, syphilis Monitor for allergy, GI upset

VI. High-Yield NCLEX Reminders

• Live vaccines: Avoid in pregnancy/immunocompromised

• Vaccine before exposure: MMR, Hep B, Varicella
• Vaccine after exposure (Post-exposure prophylaxis): Rabies, Hep B, Varicella (if no
prior immunity)
• Don’t give aspirin in viral illness (Reye’s syndrome risk in children)
• Hand hygiene is #1 prevention method!

Here are 15 advanced NCLEX-style questions on communicable diseases, including

rationales to sharpen your readiness for your comprehensive nursing exam:

NCLEX QUESTIONS — COMMUNICABLE DISEASES

1. A child with chickenpox is admitted to the pediatric unit. What type of precautions should the
nurse implement?
A. Droplet
B. Airborne and Contact
C. Contact only
D. Standard
✅ Answer: B
Rationale: Chickenpox (Varicella) is spread via airborne and contact transmission. The child
should be placed in a negative pressure room with airborne precautions and contact precautions
due to vesicular lesions.

2. A nurse is caring for a client newly diagnosed with active tuberculosis. Which finding
indicates that the client understands the teaching?
A. “I can return to work after 1 week of antibiotics.”
B. “I will cover my mouth when I cough, even at home.”
C. “I will stop taking the medications once I feel better.”
D. “TB is no longer contagious once symptoms go away.”

✅ Answer: B
Rationale: TB requires extended treatment, and clients must use cough etiquette even at home
to protect others. Treatment typically lasts 6–12 months. Infectiousness diminishes after a few
weeks of therapy but doesn’t disappear immediately.

3. Which vaccine is contraindicated during pregnancy?

A. Influenza (inactivated)
B. Tdap
C. MMR
D. Hepatitis B

✅ Answer: C
Rationale: MMR is a live attenuated vaccine and is contraindicated in pregnancy due to
potential teratogenic effects. Inactivated vaccines like Tdap and Hep B are safe.

4. A 2-month-old infant is scheduled for routine immunizations. Which vaccines should the
nurse expect to administer?
A. MMR and Varicella
B. Hep B and DTaP
C. Influenza (live) and DTaP
D. HPV and Meningococcal

✅ Answer: B
Rationale: At 2 months, the child should receive Hep B (2nd dose) and DTaP along with others
like IPV, Hib, and PCV. MMR and Varicella are given at 12–15 months.
5. A client with suspected meningococcal meningitis is admitted. What is the priority action?
A. Administer antipyretics
B. Initiate droplet precautions
C. Prepare for lumbar puncture
D. Insert IV line for antibiotics

✅ Answer: B
Rationale: Droplet precautions must be initiated immediately for suspected meningococcal
meningitis. Protection of others is critical. Other steps follow once isolation is established.

6. A client receiving INH for TB asks why vitamin B6 is prescribed. What is the best response?
A. “It reduces drug interactions.”
B. “It boosts your immune system.”
C. “It prevents peripheral neuropathy.”
D. “It enhances absorption of the TB drug.”

✅ Answer: C
Rationale: INH can deplete pyridoxine (B6), causing peripheral neuropathy. Supplementation
prevents this side effect.

7. Which finding should prompt the nurse to withhold the MMR vaccine in a child?
A. Mild fever
B. Egg allergy
C. Current antibiotic use
D. Recent chemotherapy

✅ Answer: D
Rationale: Immunocompromised patients, such as those on chemotherapy, should not receive
live vaccines like MMR. Mild illness is not a contraindication.

8. A nurse receives a needlestick injury from a patient with active Hepatitis B. What is the initial
action?
A. Begin antiviral medications
B. Administer Hepatitis A vaccine
C. Wash area with soap and water
D. Test the nurse’s Hepatitis B titer

✅ Answer: C
Rationale: First step in exposure is to wash the area thoroughly. Afterward, the nurse should
follow facility protocol for post-exposure prophylaxis (PEP), including testing and possibly
giving HBIG.

9. A patient with HIV is admitted for Pneumocystis jiroveci pneumonia. What lab value most
likely prompted this diagnosis?
A. CD4 count of 800
B. Viral load undetectable
C. CD4 count of 150
D. Hemoglobin 14 g/dL

✅ Answer: C
Rationale: PJP is an opportunistic infection common when CD4 count drops below 200. CD4
count of 150 indicates severe immunosuppression.

10. A nurse is teaching a group of college students about preventing mononucleosis. Which point
is most accurate?
A. “Avoid close contact with people who are sneezing.”
B. “Wear a mask when in public.”
C. “Avoid sharing drinks and utensils.”
D. “Use insect repellent regularly.”

✅ Answer: C
Rationale: Mononucleosis (Epstein-Barr Virus) is transmitted through saliva, often called “the
kissing disease.” Avoiding sharing drinks/utensils is key.

BONUS QUESTIONS

11. Which disease requires negative pressure isolation?

A. RSV
B. Influenza
C. Tuberculosis
D. Mumps

✅ Answer: C
Rationale: TB is an airborne disease; it requires negative pressure rooms and N95 masks.
12. A patient with suspected rubella is admitted. What action by the nurse is most important?
A. Wear an N95 respirator
B. Ask about recent travel history
C. Place a "droplet precaution" sign
D. Use contact precautions

✅ Answer: C
Rationale: Rubella is spread via droplet transmission. Wear a regular mask and isolate
appropriately.

13. What symptom is most specific to measles (rubeola)?

A. Parotid gland swelling
B. Vesicular rash
C. Koplik spots
D. Swollen lymph nodes

✅ Answer: C
Rationale: Koplik spots (tiny white spots in the mouth) are pathognomonic for measles.

14. The best time to administer oseltamivir (Tamiflu) is:

A. When the patient’s fever exceeds 39°C
B. Within 48 hours of symptom onset
C. After 5 days of symptoms
D. Only if symptoms include cough and sore throat

✅ Answer: B
Rationale: Tamiflu is most effective within 48 hours of flu symptom onset.

15. A client is diagnosed with mumps. What should the nurse assess for?
A. Hepatosplenomegaly
B. Orchitis
C. Neurogenic bladder
D. Petechial rash

✅ Answer: B
Rationale: Orchitis (testicular inflammation) is a complication of mumps in post-pubertal
males.
Absolutely! Here are 5 advanced NCLEX-style case-based scenarios on communicable
diseases — designed to test critical thinking, prioritization, infection control, and patient
education.

CASE-BASED QUIZZES: COMMUNICABLE DISEASES

✅ Case 1: Suspected Measles in a Child

Scenario:
A 3-year-old child is brought to the ER with a high fever, cough, runny nose, and red eyes. The
mother reports the appearance of a red, blotchy rash that started on the face and spread down the
body. You notice tiny white spots inside the child’s mouth.

Question:
What is the priority nursing intervention?
A. Administer acetaminophen
B. Notify infection control and place on airborne precautions
C. Start IV fluids
D. Apply calamine lotion to soothe the rash

✅ Correct Answer: B
Rationale: Measles is an airborne disease. The first step is to isolate the patient with airborne
precautions to prevent transmission.

✅ Case 2: Meningococcal Meningitis in a Dorm Student

Scenario:
An 18-year-old college student is admitted with sudden high fever, stiff neck, headache, and
photophobia. The physician suspects meningococcal meningitis.

Question:
What should the nurse do first?
A. Obtain consent for lumbar puncture
B. Place the patient in a negative pressure room
C. Initiate droplet precautions
D. Prepare to administer antibiotics

✅ Correct Answer: C
Rationale: Droplet precautions must be implemented immediately. Meningococcal meningitis
is highly contagious, and protecting others is the first priority before diagnostic tests or
treatment.

✅ Case 3: Tuberculosis Treatment Adherence

Scenario:
A 45-year-old man is being treated for active pulmonary tuberculosis. He has missed several
clinic appointments and expresses confusion about why he needs to take so many drugs.

Question:
What is the most appropriate nursing intervention?
A. Refer the patient to social services
B. Discuss enrolling in directly observed therapy (DOT)
C. Provide printed instructions and discharge him
D. Explain the consequences of missing doses

✅ Correct Answer: B
Rationale: DOT (Directly Observed Therapy) is the standard to ensure medication adherence
in TB cases. It's especially useful for noncompliant patients.

✅ Case 4: HIV Patient with Persistent Diarrhea

Scenario:
A 32-year-old male with HIV presents with chronic watery diarrhea and weight loss. His CD4
count is 75 cells/mm³. He asks why this is happening despite taking his HIV medications.

Question:
Which opportunistic infection is the nurse most concerned about?
A. Toxoplasmosis
B. Cryptosporidiosis
C. Candidiasis
D. Cytomegalovirus

✅ Correct Answer: B
Rationale: Cryptosporidiosis is a parasitic infection causing profuse, watery diarrhea in
patients with severe immunosuppression (CD4 <100). It's a common opportunistic infection in
late-stage HIV/AIDS.

✅ Case 5: Child with Pertussis

Scenario:
A 6-month-old infant presents with severe coughing fits followed by a “whooping” sound. The
mother says the baby vomits after coughing and turns red in the face.

Question:
What is the nurse’s first priority?
A. Notify the public health department
B. Place the infant on droplet precautions
C. Administer albuterol
D. Prepare for suctioning and oxygen support

✅ Correct Answer: D
Rationale: Pertussis can lead to apnea, hypoxia, and aspiration in infants. Maintaining airway
and oxygenation is the immediate priority. Droplet precautions and notification should follow.

Here are 5 more advanced NCLEX-style practice questions on communicable diseases,

designed for comprehensive exam prep — covering infection control, public health, medications,
and critical thinking.

Advanced NCLEX Practice Questions: Communicable Diseases

✅ Question 1: Hepatitis A Precautions

A nurse is caring for a client diagnosed with Hepatitis A. Which of the following actions is most
appropriate?

A. Place the client in airborne isolation

B. Implement contact precautions
C. Wear an N95 respirator when entering the room
D. Use sterile gloves when giving oral medication

✅ Correct Answer: B
Rationale: Hepatitis A is transmitted fecal-oral route, so contact precautions (especially
hand hygiene and glove use) are required. Airborne precautions and N95 masks are not
indicated.

✅ Question 2: Chickenpox Exposure in Pregnancy

A pregnant nurse is assigned to a pediatric unit where a child is admitted with varicella
(chickenpox). The nurse has never had chickenpox or the vaccine.

What should the charge nurse do?

A. Allow her to care for the patient using PPE

B. Reassign her to a non-infectious case
C. Have her wear an N95 mask
D. Advise her to receive the varicella vaccine immediately

✅ Correct Answer: B
Rationale: Varicella poses serious risks to the fetus if a pregnant woman is infected.
Reassignment is the safest action. The vaccine is contraindicated in pregnancy.

✅ Question 3: Rubella and School Notification

A 5-year-old client is diagnosed with rubella (German measles). What action should the nurse
take first?

A. Inform the school and recommend exclusion

B. Begin antiviral therapy
C. Provide antipyretics for fever
D. Schedule the next MMR vaccine dose

✅ Correct Answer: A
Rationale: Rubella is highly contagious and dangerous to pregnant women. The child should
be excluded from school, and public health protocols should be followed.

✅ Question 4: TB Medication Teaching

A client with tuberculosis is being discharged on isoniazid (INH), rifampin, and ethambutol.
Which statement by the client indicates a need for further teaching?

A. "I’ll call the doctor if my eyes feel blurry."

B. "I should avoid alcohol while on these medications."
C. "I know orange-colored urine is normal with rifampin."
D. "I can stop taking the drugs once I feel better."

✅ Correct Answer: D
Rationale: TB treatment must be continued for 6–9 months, even if the patient feels better.
Stopping early increases resistance and relapse.
✅ Question 5: Diphtheria Emergency

A child with diphtheria suddenly develops respiratory distress and stridor. What is the nurse's
immediate action?

A. Apply warm compresses to the neck

B. Prepare for tracheostomy or intubation
C. Administer diphtheria antitoxin
D. Obtain a throat culture

✅ Correct Answer: B
Rationale: Diphtheria causes a pseudomembrane in the airway that can obstruct breathing. The
priority is airway management.

Here is another set of 5 advanced NCLEX-style communicable disease questions — case-

based, critical-thinking heavy, and ideal for final exam prep.

CASE-BASED NCLEX QUESTIONS: COMMUNICABLE DISEASES –

SET 3

✅ Case 1: Scarlet Fever in a Child

Scenario:
A 6-year-old child presents with a sore throat, fever, and a "sandpaper-like" rash on the trunk.
The rapid strep test is positive. The mother asks if the child can return to school tomorrow.

Question:
What is the nurse’s best response?

A. “Your child can return after the fever resolves.”

B. “Return after completing a full 10-day course of antibiotics.”
C. “The child may return 24 hours after starting antibiotics.”
D. “Stay home until the rash is completely gone.”

✅ Correct Answer: C
Rationale: Scarlet fever is caused by group A strep. The child may return to school 24 hours
after starting antibiotics and being fever-free. The rash may persist even after the child is no
longer infectious.

✅ Case 2: Zika Virus and Pregnancy

Scenario:
A nurse is providing pre-travel counseling to a newly pregnant client. The client plans to visit a
country with recent Zika virus outbreaks.

Question:
What is the nurse’s priority teaching?

A. “Avoid undercooked food.”

B. “Get the yellow fever vaccine.”
C. “Do not travel to areas with Zika outbreaks.”
D. “Take acetaminophen daily to prevent symptoms.”

✅ Correct Answer: C
Rationale: Zika virus is linked to microcephaly and other fetal brain defects. Pregnant
women should avoid travel to affected areas.

✅ Case 3: Hand-Foot-and-Mouth Disease

Scenario:
A toddler is brought to the clinic with a fever, reduced appetite, and small vesicles on the hands,
feet, and inside the mouth.

Question:
What is the most appropriate nursing action?

A. Start antiviral therapy

B. Place the child on airborne precautions
C. Provide fluids and encourage oral intake
D. Administer antibiotics as prescribed

✅ Correct Answer: C
Rationale: Hand-foot-and-mouth disease is viral, self-limiting, and managed with supportive
care like fluids and fever control.
✅ Case 4: Ebola Suspect Patient

Scenario:
A traveler recently returned from West Africa with a high fever, body aches, and bleeding gums.
Ebola is suspected.

Question:
What is the priority nursing action?

A. Start IV fluids and prepare blood work

B. Notify the CDC and implement full isolation
C. Give acetaminophen and send home
D. Begin empiric antibiotic therapy

✅ Correct Answer: B
Rationale: Ebola requires immediate public health notification and strict isolation (airborne +
contact). Infection control and safety come first.

✅ Case 5: MRSA Surgical Site Infection

Scenario:
A post-op patient has redness, purulent drainage, and pain at the incision site. A wound culture
reveals MRSA.

Question:
Which infection control precaution is required?

A. Airborne precautions with N95 mask

B. Contact precautions with gown and gloves
C. Droplet precautions with surgical mask
D. Neutropenic precautions

✅ Correct Answer: B
Rationale: MRSA requires contact precautions. Use gloves and gown, especially with wound
drainage.

Absolutely! Here’s another set of 5 advanced NCLEX-style case-based questions focusing on

communicable diseases, perfect for sharpening your critical thinking and test readiness.
 CASE-BASED NCLEX QUESTIONS: COMMUNICABLE DISEASES –
SET 4

✅ Case 1: Measles Outbreak

Scenario:
During a measles outbreak, a nurse is caring for a 3-year-old child who presents with cough,
conjunctivitis, and Koplik spots. The parent asks when the child will no longer be contagious.

Question:
What is the nurse’s best response?

A. “Your child is contagious until the fever is gone.”

B. “Your child is contagious until the rash disappears.”
C. “Your child is contagious 4 days before and after the rash appears.”
D. “Your child is not contagious once antibiotics are started.”

✅ Correct Answer: C
Rationale: Measles is highly contagious 4 days before and 4 days after rash onset. It’s a
viral illness, so antibiotics aren’t effective.

✅ Case 2: Pertussis (Whooping Cough)

Scenario:
An infant is admitted with persistent cough spells followed by vomiting and facial redness.
Pertussis is suspected.

Question:
What is the priority nursing action?

A. Keep the infant NPO to prevent aspiration

B. Administer antitussive medications
C. Monitor for apnea and oxygen saturation
D. Apply cool mist to the face during coughing spells

✅ Correct Answer: C
Rationale: Apnea and hypoxia are major complications of pertussis, especially in infants.
Monitor closely for respiratory compromise.
✅ Case 3: Influenza in the Elderly

Scenario:
An elderly resident in a nursing home is diagnosed with influenza A. Other residents are at high
risk.

Question:
What is the best infection control strategy?

A. Start oseltamivir for all residents with symptoms

B. Isolate the client and give flu shots to exposed staff
C. Provide antibiotics to all residents preventively
D. Increase staff to resident ratio for safety

✅ Correct Answer: A
Rationale: Oseltamivir (Tamiflu) is used as post-exposure prophylaxis and treatment. Start
for all symptomatic or high-risk contacts during outbreaks.

✅ Case 4: Meningococcal Meningitis

Scenario:
A college student is diagnosed with bacterial meningitis. The nurse is preparing to admit the
patient to the unit.

Question:
Which precaution must be implemented?

A. Airborne
B. Contact
C. Droplet
D. Standard

✅ Correct Answer: C
Rationale: Meningococcal meningitis is spread via droplets. Use mask within 3 feet of the
patient. Airborne is not necessary unless TB is suspected.

✅ Case 5: Tetanus Wound Care

Scenario:
A farmer presents with a puncture wound from rusty metal and does not remember his last
tetanus shot.
Question:
What is the nurse’s priority action?

A. Administer tetanus immunoglobulin (TIG) and Tdap

B. Irrigate the wound with hydrogen peroxide
C. Apply antibiotic ointment and dry dressing
D. Observe for 24 hours for signs of tetanus

✅ Correct Answer: A
Rationale: For dirty wounds with unknown vaccine status, give both tetanus
immunoglobulin for immediate protection and Tdap to initiate immunity.